Does It Or Doesn’t It?

The Henry Ford Health System is an organization of six hospitals, nine emergency rooms, 40 general medical centers, and seven specialized medical facilities. It is a major provider of health care in the Detroit Metro area. The Detroit News reports on a study in the system that is sure to cause some controversy:

A Henry Ford Health System study shows the controversial anti-malaria drug hydroxychloroquine helps lower the death rate of COVID-19 patients, the Detroit-based health system said Thursday.

Officials with the Michigan health system said the study found the drug “significantly” decreased the death rate of patients involved in the analysis.

The study analyzed 2,541 patients hospitalized among the system’s six hospitals between March 10 and May 2 and found 13% of those treated with hydroxychloroquine died while 26% of those who did not receive the drug died.

Among all patients in the study, there was an overall in-hospital mortality rate of 18%, and many who died had underlying conditions that put them at greater risk, according to Henry Ford Health System. Globally, the mortality rate for hospitalized patients is between 10% and 30%, and it’s 58% among those in the intensive care unit or on a ventilator.

“As doctors and scientists, we look to the data for insight,” said Steven Kalkanis, CEO of the Henry Ford Medical Group. “And the data here is clear that there was a benefit to using the drug as a treatment for sick, hospitalized patients.”

Could the difference between this finding and those of other studies that found no benefit be the race of those being treated? Or could it be due to the timing of receiving the drug?

Patients with a median age of 64 were among those analyzed, with 51% men and 56% African American. Roughly 82% of the patients began receiving hydroxychloroquine within 24 hours and 91% within 48 hours, a factor Dr. Marcus Zervos identified as a potential key to the medication’s success.

As noted above this finding is sure to provoke comment, given the other studies finding the opposite and the politicization of the drug.

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Happy Birthday, Olivia!

I missed this. Yesterday was Olivia DeHavilland’s 104th birthday. Happy Birthday, Olivia!

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What Credibility?

In an op-ed in the Wall Street Journal physician Joseph A. Ladapo admonishes politicians and “medical experts” that the politicization of the response to COVID-19 impairs their credibility:

Political leaders and health officials have often invoked “science” to justify decisions manifestly guided by their personal preferences. That costs them credibility. Restoring public confidence will require acknowledging their role in politicizing the pandemic, yielding to accommodations and sensible alternatives in the areas of greatest controversy, and focusing on the widely supported goal of not overwhelming hospitals, rather than less meaningful metrics such as increases in Covid-19 cases.

Recommending to politicians that they not politicize is like telling fish not to swim or birds not to fly. And credibility? For anyone who really cared there isn’t a single politician holding on to a shred of credibility in the entire country. What does credibility matter when you have a “safe seat”?

He advises:

If political leaders and health experts want to restore their credibility and the public’s confidence, they need to begin by acknowledging that politics rather than science has influenced important public-health decisions and by making accommodations for dissenting perspectives. Alternatives to masks, for instance, include physical distancing and using face shields while indoors.

And while there is more to learn about immunity, there has not been a single confirmed case of reinfection among the 10 million cases of Covid-19 world-wide, according to a May report in the Journal of the American Medical Association. Until the data say otherwise, people who have recovered from Covid-19 should be exempt from restrictions.

The most important step political leaders and health officials can take is to base their decisions on hospital capacity, rather than case counts, which inevitably will continue to increase among low-risk young people. Policing of social distance and restrictions on personal, educational and business activities are fueling culture wars. Focusing on the goal of not overwhelming hospitals is sensible and less vulnerable to politicization—so long as the data are publicly available for independent analysis. Hospitals often run near capacity to maximize profits, so the promises made during shutdowns to increase capacity need to be fulfilled—or capacity will become a political weapon.

Since citizens are already opting out of high-risk activities they want to avoid, let them enter bars, enjoy the beach, exercise at the gym, and learn in school if they choose. The government should intervene with mandates and closures only if regional hospital capacity requires it, while being transparent about bed availability, illness severity of hospitalized patients, and efforts to increase treatment capacity, including the supply of promising medications such as remdesivir and dexamethasone.

Here in Illinois only 10% of ICU beds are presently occupied by patients with COVID-19. In Chicago I suspect that more ICU beds are occupied by gunshot victims than people with COVID-19.

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The Inevitable

Both the editors of the Washington Post and the Wall Street Journal are outraged by Beijing’s overnight end of its “one country two systems” policy with respect to Hong Kong. From the WaPo:

HONG KONG as it has been known — a bastion of free speech and rule of law, an autonomous, glittering capital of capitalism — has been smothered. Overnight, China has imposed a new national security law of six chapters and 66 articles that will criminalize dissent and install a system of secret police, putting the territory under the same authoritarian boot as the mainland. President Trump has been signaling for a long time that he would not stand up for human rights and democracy in Hong Kong. Perhaps not surprisingly, China acted with brusque indifference to protests from the West.

The law was passed in secret by the Standing Committee of the National People’s Congress in Beijing and signed by President Xi Jinping before people in Hong Kong had even seen the text.

and the WSJ:

China’s decision to impose its national-security law on Hong Kong is a seismic event that goes well beyond the sad fate of its 7.5 million people. The illegal takeover shows that Beijing’s Communist rulers are willing to violate their international commitments with impunity as they spread their authoritarian model.

We say this with regret because we were among those who hoped, amid China’s reform era that began in the 1980s, that the Middle Kingdom could be drawn into a world of peaceful global norms. Hong Kong, a showcase of the prosperity that economic freedom and the rule of law can produce, was a lesson for Beijing to learn from.

What astonishes me is that they could possibly imagine it might have been otherwise. As I have been saying for decades, China is irredentist. The CCP maintains its hold on power through force and repression. There is no international accord to which China is a signatory that it has not violated.

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They’ve All Failed

I agree with the caption on the editors’ of the Washington Post’s latest editorial: “Americans sacrificed to flatten the curve. Their leaders have let them down.” I have reservations about just about everything else in the editorial. I’m afraid that Captain Bezos’s obsession with killing the Great Orange Whale is clouding the editors’ critical faculties. I’m going to try my best not to fisk the editorial and instead just concentrate on a few highlights.

First, the elephant in the room. There is one action that could have saved the lives of hundreds of thousands of people and that action could only have been taken by one person: Chinese President Xi. If China had suspended travel in or out of the country early enough in their COVID-19 outbreak, it might have saved the lives of the Italians, Spaniards, Americans, Brazilians, and others who’ve died of the disease. If he hadn’t suppressed the information that the disease was being contracted via “community spread” as soon as they knew it, at the very least it would have given other countries more time to prepare for what was to come. Those lives are on his head and let’s not lose track of that in political infighting.

Now onwards to our domestic problems. There are things that President Trump was negligent in not doing:

  1. He should have suspended all international travel when he suspended travel by Chinese travelers to the U. S.
  2. He should have been much tougher with the FDA and CDC. After they’d had two weeks to futz around, producing a test should have been opened to the private sector.
  3. He should have used his authority under the Defense Production Act for masks, ventilators, and tests.
  4. He should have directed the CDC to come up with a nationwide epidemiological testing plan and put it into action. That should have happened a month ago.

All of those could have been done without a declaration of martial law under legal authority the president already has. Whether presidents should have that authority is a question for another post.

Back to the editorial. I think this is mistaken:

Experts have identified the best strategy: test, to find out who is sick; trace, to find out who may be sick; and isolate those who are suffering. Personal habits must accompany this: wearing face masks, hand washing, physical distancing and avoiding crowds in enclosed spaces.

The strategy worked in nations that pursued it with conviction, such as South Korea and Germany.

What the actual experts on the front lines have been doing is testing to confirm those who are sick and treating them. That’s no national epidemiological plan. Some states have began their own epidemiological testing plans but that’s inadequate.

Additionally, a better diction would be “The strategy worked in strongly cohesive countries with high levels of compliance but, unfortunately, the U. S. is not such a country.” Furthermore, are we actually sure that South Korea has faced the same strain of the virus we have? I do not trust anything coming out of China these days but the Chinese have claimed that the strain they’re seeing now is not the same one they were facing back in January.

The “Test—Trace—Isolate” strategy is not the only one. I’m skeptical that contact tracing would be practicable under our circumstances. How about Portugal’s strategy of isolating the most vulnerable from the very outset? It appears to have been quite successful: their mortality rate is lower than any of their neighbors.

Finally, nowhere do the editors mention the gross negligence on the part of state and local officials that have led to the loss of so many jobs and the deaths of so many of those in “nursing homes”. There is plenty of blame to spread around.

It also should be mentioned that regardless of all of the breastbeating the mortality rates per million population in California, Texas, and Florida remain tiny fractions of those in the Washington-Boston corridor.

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Some Sort of Record

Eight members of the Toledo City Council have not been arrested for accepting bribes. ABC Toledo reports:

TOLEDO (WTVG) – Four members of the Toledo City Council have been accused of accepting bribes while in office, according to court documents obtained by 13abc on Tuesday. At least three of those council members have been placed into federal custody. 13abc crews were on the scene as council members Larry Sykes and Yvonne Harper were placed into custody. Federal documents also implicate council members Gary Johnson and Tyrone Riley.

According to a criminal complaint filed with the U.S. District Court, Councilman Sykes faces complaints of “Reciept of Bribe by Agent of Organization Receiving Federal Funds” and “Hobbs Act Extortion Under Color of Official Right.” In the affidavit filed along with the complaint, council members Harper, Riley, and Jonson are also named as subjects.

I wonder if Chicago would fare as well.

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Around Some Future Corner

This interview with Toyota autonomous vehicle developers at IEEE Spectrum supports what I’ve been saying for years about autonomous vehicles rather neatly. Short version: don’t expect a fully autonomous vehicle to pull up on the road next to you any time soon.

The foundations for what the interviewees refer to in the article as “deep learning” were there sixty years ago. There have been no basic developments since. What there has been is hardware that’s small and cheap enough to do things that were impractical sixty years ago. As I sometimes put it my smartphone has more compute power than all of the computers I’d ever worked on until 1980 put together.

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RIP Carl Reiner, 1922-2020

Carl Reiner has died. From Variety:

Carl Reiner, the writer, producer, director and actor who was part of Sid Caesar’s legendary team and went on to create “The Dick Van Dyke Show” and direct several hit films, has died. He was 98.

He died of natural causes on Monday night at his home in Beverly Hills, his assistant Judy Nagy confirmed to Variety.

Reiner, the father of filmmaker and activist Rob Reiner, was the winner of nine Emmy awards, including five for “The Dick Van Dyke Show.” His most popular films as a director included “Oh God,” starring George Burns, in 1977; “The Jerk,” with Steve Martin, in 1979; and “All of Me,” with Martin and Lily Tomlin, in 1984.

Rob Reiner tweeted on Tuesday morning, “Last night my dad passed away. As I write this my heart is hurting. He was my guiding light.”

I’m at a loss for words. I can barely remember a time when Carl Reiner wasn’t making me laugh. I remember his and Mel Brooks’s appearances on Your Show of Shows nearly 65 years ago vividly.

Is there anything funny any more?

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If We Had Some Ham

More than anything else, Lawrence Summers’s and Anna Stansbury’s Washington Post op-ed making the argument that the way to reverse the declining share of income claimed by labor is to increase the power of unions, reminds me of the old vaudeville joke: “If we had some ham, we could make a ham and cheese sandwich if we had some cheese.” Consider:

Economic analysis often ascribes these trends to some combination of globalization, technological change and rising monopoly power. But our research suggests that a more compelling explanation is the broad-based decline in worker power. As workers have become less able to share in the profits generated by their firms, income has been redistributed from employees to the owners of capital. That has contributed to higher income inequality along class and race lines.

The evisceration of private-sector unions is the most obvious example of the decline in worker power. At the peak, one-third of the private-sector workforce belonged to a union; that number is now 6 percent. But other factors also affect the degree to which workers can share in firms’ profits. Because of increased shareholder activism, rising levels of debt, increases in private equity and changing corporate norms, businesses are increasingly run for shareholders rather than their stakeholders. Ruthless management tactics involving precise measurement of workers’ day-to-day activity have become widespread.

Meanwhile, workers at large firms or in highly paid industries (such as manufacturing, construction or transportation) used to earn large wage advantages, as they shared in the profits generated by their companies, but these benefits have declined by half since the early 1980s. An increasing number of workers are outsourced domestically, employed by staffing or temp agencies or misclassified as independent contractors, reducing their ability to share in the profits of the main firm they work for. And the real value of the minimum wage is lower than it was in the 1970s.

Why did this happen? Some portion of the decline in worker power may have been an inevitable outcome of globalization or technological change. But our research — which examines shifts in labor shares and corporate profits across different industries — indicates that changes in policy, norms and institutions are the most important explanatory factors. This view is supported by the fact that the legal and political environment has been tilted substantially in favor of shareholders and against workers since the 1980s, a trend exemplified by the expansion of state right-to-work laws undermining unions’ ability to fund themselves and the increasing corporate use of union avoidance tactics, both legal and illegal. The fact that the decline in unionization, the rise in income inequality and the fall in labor’s share of income have all happened to a greater extent in the United States than in much of the rest of the industrialized world also suggests an important role for U.S.-specific explanations.

See what I mean? The decline in bargaining power is less a consequence of globalization, technological change, or consolidation than it is due to reduced workers power which is due to globalization, technological change, and consolidation. If you read very carefully you can ferret out their proposals for remedying the situation:

  • Eliminate right to work laws
  • Ensure that workers that aren’t actually independent workers are not classified as such
  • Sector level collective bargaining

Fair enough. How? Constitutional amendment? And how do they propose to reduce offshore outsourcing in the face of rising U. S. labor costs? I genuinely want to know.

The art of making policy resides in identifying the alternatives, weighing their costs and benefits, and pursuing the most doable. Contrary to Dr. Summers I would attribute the decline in union power overwhelmingly to globalization, technological change, consoolidation and their run-on effects as well as the following:

  • Union corruption
  • Obeisance of the unions to the Democratic Party even as the party abandoned policies that bolstered workers’ power in favor of neoliberal policies.
  • The adversarial relationship between organized labor and corporations built into our legal system.
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We Are Not Alone

Have you ever seen Close Encounters of the Third Kind? What’s it about? Don’t recap its plot for me—what’s it about? I think it’s about awe—the ability to look at the night sky and see wonder and adventure and magnificence. I just finished watching a movie, streaming on Amazon Prime, that covers some of the same territory as Close Encounters. In my opinion it is a better movie, better acted, more affecting, and was probably made for 1% of the budget of Close Encounters. The movie is Cosmos (2019).

If your idea of a great science fiction movie is anything directed by Michael Bay or produced by James Cameron do not waste your time with Cosmos. You will hate it. There are no big name Hollywood starts, no explosions, no stunning digital effects, no sex, no nudity. Most of it is just three guys shot in a car. In it.

If the future of movies is something that can open simultaneously in 5,000 cineplexes and will appeal to the Chinese audience, IMO movies have no future. If the future of movies is more like Cosmos, the future is bright.

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